The status of immunization program and challenges in Ethiopia: A mixed method study.

Introduction: Immunization helps reduce morbidity and mortality attributable to severe vaccine-preventable childhood illnesses. However, vaccination coverage and the quality of immunization data remain challenging in Ethiopia. This has led to poor planning, suboptimal vaccination coverage, and the resurgence of vaccine-preventable disease outbreaks in under-immunized pocket areas. The problem is further compounded by the occurrence of the COVID-19 pandemic and the disruption of the health information system due to recurrent conflict. This study assessed the current status of the immunization service and its challenges in Ethiopia. Methods: A mixed-methods study was conducted in three regions of Ethiopia from 21 to 31 May, 2023. A survey of administrative reports was done in a total of 69 health facilities in 14 woredas (districts). Nine KIIs were conducted at a district level among immunization coordinators selected from three regions to explore the challenges of the immunization program. Linear regression and descriptive statistics were used to analyze the quantitative data. Thematic analysis was applied to analyze the qualitative data. The findings from the qualitative data were triangulated to supplement the quantitative results. Result: Two-thirds (66.4%) of the children were fully vaccinated, having received all vaccines, including the first dose of the MCV1, by 12 months of age, as reported through administrative reports collected from health facility records. Catchment area population size and region were significantly associated with the number of fully immunized children (p < 0.001 and p = 0.005, respectively). The vaccination dropout rates of the first to third dose of pentavalent vaccine and the first dose of pentavalent vaccine to the first dose of MCV1 were 8.6% and 7.4%, respectively. A considerable proportion of health facilities lack accurate data to calculate vaccination coverage, while most of them lack accurate data for dropout rates. Longer waiting time, interruptions in vaccine supply or shortage, inaccessibility of health facilities, internal conflict and displacement, power interruption and refrigerator breakdown, poor counseling practice, and caretakers' lack of awareness, fear of side effects, and forgetfulness were the reasons for the dropout rate and low coverage. The result also showed that internal conflict and displacement have significantly affected immunization coverage, with the worst effects seen on the most marginalized populations. Conclusion: The study revealed low vaccination coverage, a high dropout rate, and poor quality of immunization data. Access and vaccination coverage among marginalized community groups (e.g., orphans and street children) were also low. Hence, interventions to address organizational, behavioral, technical, and contextual (conflict and the resulting internal displacement) bottlenecks affecting the immunization program should be addressed.

Preparation and application of zeolite-zinc oxide nano composite for nitrate removal from groundwater.

Nanomaterial assisted removal of pollutants from water has got great attention. This study aimed to remove nitrate from groundwater using zeolite and zeolite-ZnO nanocomposite as synergetic effect. Zeolite-ZnO nanocomposite was prepared using the co-precipitation method. The Physico-chemical characteristics of the nanomaterials were determined using XRD, SEM, and FTIR. The results revealed that; Zeolite-ZnO nanocomposites with 13.12 nm particle size have successfully been loaded into the zeolite. In addition, its chemical composition was determined using AAS. The removal efficiency of nitrate from groundwater was studied using a batch experiment. The removal of nitrate was investigated as a function of adsorbent dose, pH, initial concentration of nitrate, contact time, and agitation speed. Moreover, the adsorption isotherm and kinetics were also determined. The results showed that the removal of nitrate was 92% at an optimum dose of 0.5 g, pH 5, initial nitrate concentration of 50 mg/L, the contact time of 1 h, and agitation speed of 160 rpm. The removal nitrate has been fitted well by the Langmuir isotherm model with correlation coefficients of R2 = 0.988. Thus, indicating the applicability of monolayer coverage of the nitrate ion on the surface of the nanocomposite. The adsorption process follows the pseudo-second-order model with a correlation coefficient of R2 = 0.997. The results of this work might find application in remediation of water by removing nitrate to meet the standards of water quality.

Clinical Implications of Herbal Supplements in Conventional Medical Practice: A US Perspective.

Herbal supplements are common complementary and alternative medicine (CAM) approaches with an ever-increasing use trend in the last two decades among the US population. Self-medication with herbal supplements which are promoted for general well-being, weight loss, immunity, and memory boost, and mental and physical health claims are very prevalent. There is a misperception that herbal supplements are harmless as they are prepared from natural sources. Unlike conventional drugs, the US Food and Drug Administration (FDA) does not regulate herbal supplements for premarketing purity and potency. Hence, there is a growing concern for health risks due to misbranded toxic ingredients, contaminants, adulterants, and herb-drug interactions (HDI) with co-administered drugs. The spectrum of pharmacological and toxicological effects of herbal supplements includes deranged lab results, allergic reactions, genotoxicity, carcinogenicity, teratogenicity, organ damage, and even fatality contributing to sizable emergency visits and hospitalizations in the US. The use of herbal supplements should be carefully monitored in high-risk groups such as pediatric and geriatric populations, pregnant women, breastfeeding mothers, immunocompromised patients, and surgical candidates. The deleterious health effects of herbal supplements are loosely addressed in conventional medical practice in part due to the limited knowledge of practitioners. This comprehensive narrative review aims to explore the clinical implications of herbal supplements in order to fill the knowledge gaps by summarizing scientific publications. It also highlights the pivotal roles physicians can play in minimizing the health risks of herbal supplements by encouraging patients to disclose usage through a non-judgmental approach, employing HDI screening tools, and reporting adverse reactions to FDA. Formal training of physicians, a standardized pharmacovigilance system, stricter regulation of the herbal industry, and more scientific studies are keys to establishing herbal safety and efficacy in clinical practice.

Nonalcoholic Fatty Liver Disease: An Emerging Modern-Day Risk Factor for Cardiovascular Disease.

Nonalcoholic fatty liver disease (NAFLD), also named metabolic dysfunction-associated fatty liver disease (MAFLD), is a progressive disease spectrum encompassing simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. It is a clinically silent disease leading to multiple extra-hepatic complications/comorbidities. It is an independent risk factor for cardiovascular disease (CVD), increasing susceptibility to hypertension, atherosclerosis, arrhythmia, myocardial dysfunction, cardiac valve deformation, and venous thrombosis through putative mechanisms including systemic inflammation, endothelial dysfunction, oxidative stress, insulin resistance, and altered lipid metabolism. Eventually, it increases the CVD prevalence, incident, and fatality, contributing to a huge health care burden. In fact, CVD is becoming the leading cause of mortality among patients with NAFLD. Other cardiometabolic risk factors coexisting with NAFLD may also accelerate the synergistic development of CVD, which warrants assessment targeting hypertension, diabetes mellitus (DM), obesity, and dyslipidemia to be an integral part of NAFLD care. Monitoring metabolic biomarkers (glucose, glycosylated hemoglobin [HbA1c], insulin, lipids, and lipoproteins), cardiovascular (CV) risk scores (American College of Cardiology/American Heart Association [ACC/AHA] or Framingham), and subclinical atherosclerosis (coronary artery calcification [CAC], carotid intima-media thickness [CIMT], and carotid plaque) are recommended for risk prediction and reduction. There is no universally accepted treatment for NAFLD, and lifestyle changes with weight loss of at least 10% are the mainstay of management. Combination therapy of ezetimibe and statins have a cardioprotective effect and help reduce liver fat. Despite being an emerging risk factor for CVD and its rapidly increasing pattern affecting a quarter of the global population, NAFLD remains overlooked and undetected, unlike the other traditional risk factors. Hence, we conducted a comprehensive narrative review to shed more light on the importance of screening CVD in NAFLD patients. PubMed indexed relevant articles published from 2002 to 2022 (20 years) were searched in April 2022 using medical subject headings (MeSH) as "nonalcoholic fatty liver disease" [Mesh] AND "cardiovascular diseases" [Mesh]. Evidence from 40 observational studies, three clinical trials, one case series, 45 narrative reviews, four systematic reviews and meta-analyses, three systematic reviews, and one meta-analysis were summarized on the epidemiologic data, pathophysiologic mechanisms, clinical features, diagnostic modalities, overlapping management, perceived challenges and health literacy regarding the CVD risk attributed to NAFLD.

Prescribing Pattern of Dermatological Compounding in Ethiopia: The Case of ALERT Hospital.

BACKGROUND: Skin diseases are among the major contributors of disease burden in Ethiopia affecting individuals of all age. Extemporaneous compounding of topical medications serves as a necessary option to treat skin diseases when manufactured medications could not meet specific patient needs. Different classes of drugs are commonly used for the treatment of dermatologic diseases. Failure to periodically assess the prescribing pattern and patient needs may lead to inappropriate planning and implementation that ultimately compromise the service. Periodic prescription analysis for compounded medications helps to monitor the prescription pattern with respect to medication selection, disease condition, dosage form types and other relevant parameters. The current study was conducted to analyze the pattern of compounding prescriptions for dermatologicals in ALERT hospital. METHODS: A cross-sectional design was conducted by retrospectively evaluating compounding prescription records of January and July, 2021. A total of 460 prescriptions in the hospital community pharmacy were systematically selected. Data related to disease pattern, product selection and dosage form type were extracted and analyzed. Data analysis was done using software for the statistical package for social science version 25.0. RESULTS: A total of 441 prescriptions containing dermatological products for compounding were analyzed. Most patients were female (62.8%) and aged 30-64 years (44.0%). Psoriasis (36.2%), acne vulgaris (15.3%), and rosacea (13.4%) were the top 3 skin diseases for which the compounding preparations were prescribed. Salicylic acid (38.0%) was the most frequently prescribed drug followed by betamethasone (20.2%); while white petrolatum (47.2%) was the most common diluting agent used for compounding. CONCLUSION: Psoriasis was the major dermatologic disease for compounding prescriptions and salicylic acid was the most frequent product used in compounding for treatment of the prescribed skin diseases.

Magnitude of metabolic syndrome and its predictors among patients on second-generation antipsychotic drugs at six psychiatry clinics and mental hospitals, in Addis Ababa, Ethiopia, 2019; Multicenter cross-sectional study.

AIMS: Second-generation antipsychotics are an important component in the management of psychiatric conditions but their use can also lead to weight gain, diabetes, and dyslipidemia. Thus, this study aimed to assess the magnitude of metabolic syndrome and its predictors among patients who were on second-generation antipsychotic drugs at six psychiatry Hospitals, in Addis Ababa, Ethiopia, 2019. METHOD: This study was conducted using a Multicenter cross-sectional study design. Medical charts of 510 patients on second-generation antipsychotic drugs who were selected by convenience sampling method and complete patients' charts were included in this study. Data was gathered using a checklist from patients' medical charts. To identify the determinants of metabolic syndrome, a logistic regression model was used. RESULT: From a total of 510 patients' Medical charts on the second-generation antipsychotic drugs, 270 (52.9%) of them were females and 240 (47.1%) were males. The magnitude of metabolic syndrome among patients receiving second-generation antipsychotic drugs was found to be 88 (17.8%). Age, education, family history of cardiovascular disease, and type of second-generation antipsychotic drugs are found to be significantly associated factors with metabolic syndrome. CONCLUSIONS: Considerable proportion of patients receiving second-generation antipsychotic medications have metabolic syndrome.

Glycemic control and its determinants among patients with type 2 diabetes mellitus at Menelik II Referral Hospital, Ethiopia.

OBJECTIVE: The objective of the study was to explore the level of glycemic control and its determinants among patients with type 2 diabetes mellitus at Menelik II Referral Hospital, Addis Ababa, Ethiopia. METHODS: Cross-sectional study design was employed. The sample size was determined using a single proportion formula and 245 patients with type 2 diabetes mellitus were involved in this study. Systematic sampling method was used to select the study subjects. Standard questionnaire was used to collect patient's biographic data, economic data, self-care activities, and patient compliance to medications. Summary statistics of a given data were calculated. Logistic regression model was used to measure the relationship between the outcome and predictor variable. Direction and strength of association was expressed using odds ratio and 95% confidence interval. RESULT: More than three-fourth, 191 (80.3%) of diabetic patients had poor glycemic control. Poor glycemic control was found to be 7.03 times higher among diabetic patients with duration of 5-10 years (adjusted odds ratio = 7.03, 95% confidence interval = 2.7-18.6). Similarly, diabetic patients with a duration of above 10 years were poorly controlled their blood sugar level (adjusted odds ratio = 2.3, 95% confidence interval = 1.028-5.08) in comparison to diabetic patients with a duration of fewer than 5 years. It was also found that compliance with a specific diet was significantly associated with good control of blood sugar level (adjusted odds ratio = 3.7, 95% confidence interval = 1.24-11.13). CONCLUSION: The magnitude of patients with poor glycemic control was high. Duration of diabetes and non-compliance with diets high in fruits, vegetables, and diets low in fat and sugar were significantly related to uncontrolled blood glucose levels. Therefore, developing strategies targeted toward improving blood glucose control with special attention to diabetes mellitus (DM) patients with a duration of ⩾5 years and those who poorly comply with their diet was strongly recommended.

Predictors of Coronavirus Disease 2019 (COVID-19) Prevention Practices Using Health Belief Model Among Employees in Addis Ababa, Ethiopia, 2020.

BACKGROUND: Ethiopia has taken strict preventive measures against COVID-19 to control its spread, to protect citizens, and ensure their wellbeing. Employee's adherence to preventive measures is influenced by their knowledge, perceived susceptibility, severity, benefit, barrier, cues to action, and self-efficacy. Therefore, this study investigated the predictors of COVID-19 prevention practice using the Health Belief Model among employees in Addis Ababa, Ethiopia, 2020. METHODS: Multicentre cross-sectional study design was used. A total of 628 employees selected by systematic sampling method were included in this study. Data were collected using a pretested self-administered questionnaire. Summary statistics of a given data for each variable were calculated. Logistic regression model was used to measure the association between the outcome and the predictor variable. Statistical significance was declared at p-value<0.05. Direction and strength of association were expressed using OR and 95% CI. RESULTS: From a total of 628 respondents, 432 (68.8%) of them had poor COVID-19 prevention practice. Three hundred ninety-one (62.3%), 337 (53.7%), 312 (49.7), 497 (79.1%), 303 (48.2%) and 299 (52.4%) of the respondents had high perceived susceptibility, severity, benefit, barrier, cues to action and self-efficacy to COVID-19 prevention practice, respectively. Employees with a low level of perceived barriers were less likely to have a poor practice of COVID-19 prevention compared to employees with a high level of perceived barrier [AOR = 0.03, 95% CI (0.01,0.05)]. Similarly, employees with low cues to action and employees with a low level of self-efficacy were practiced COVID prevention measures to a lesser extent compared those with high cues to action and high level of self-efficacy [AOR = 0.05, 95% CI (0.026,0.10)] and [AOR = 0.08, 95% CI (0.04,0.14)], respectively. CONCLUSION: The proportion of employees with poor COVID-19 prevention was high. Income, perceived barrier, cues to action, and self-efficacy were significantly associated with COVID-19 prevention practice.

Healthcare Worker's Knowledge, Attitude, and Practice of Proper Face Mask Utilization, and Associated Factors in Police Health Facilities of Addis Ababa, Ethiopia.

BACKGROUND: Face masks were considered as an effective method of preventing respiratory infections like coronavirus infection. Identifying knowledge, attitude, and practice of healthcare workers regarding face mask utilization is very important to identify gaps and intervene immediately to control the spread of the infection. Hence, the main aim of this study was to determine the health worker's knowledge, attitude, and practice of proper face mask utilization and associated factors at police health faculties in Addis Ababa, Ethiopia, 2020. METHODS: Across-sectional, quantitative approach study was conducted from June to July 2020. The study covered 408 health professionals of all categories working in the different police health facilities found in Addis Ababa, Ethiopia, during the study period. Data were collected using a pre-tested self-administered questionnaire adopted from different studies after getting consent from the study participants. After the data were collected, it was entered and analyzed using SPSS version 23 computer software. A logistic regression model was used to measure the association between the predictor and outcome variables. Statistical significance was declared at p-value<0.05. Direction and strength of association were expressed using OR and 95% CI. RESULTS: The study showed that the overall knowledge, attitude, and practice of the healthcare provider towards proper face mask utilization were 98 (33.5%), 185 (45.3%), and 272 (33.3%) respectively. Factors associated with proper utilization of face mask were educational status (AOR = 10.4, 95% CI: 2.51, 43.32), police rank (AOR=0.2. CI: 0.05, 0.41), profession (AOR = 7.7, 95% CI: 2.63, 22.65), and knowledge about face mask use (AOR = 0.01, 95% CI: 0.003, 0.023). CONCLUSION: In this study, the level of knowledge and attitude towards face mask utilization was relatively low, and the level of proper face mask utilization was quite low in comparison with some studies. Comprehensive training about a face mask that focuses on its proper use should be designed and given by the authorities to healthcare workers who are on the front-line in the fight against COVID-19.

Assessment of Magnitude of Consistent Condom Use and Associated Factors Among Police Force at Riot Control, Addis Ababa, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Police officers are grouped among the most at-risk population for HIV. Most police officers who are mobile related to work behavior might be at risk of HIV for themselves and/or the main source of infection in transmitting the disease to the police members. So the basic aim of this study was to determine the magnitude of condom use and associated factors among police force riot control in Addis Ababa in September 2015. MATERIALS AND METHODS: An institutional-based cross-sectional quantitative survey was conducted among a sample of 400 police officers. The sample size was calculated using a single size proportion formula by considering 52% prevalence of multiple sexual partners. A systematic random sampling technique was used to get study subjects from the institution. A pretested structured questionnaire was employed to obtain the necessary information after getting both written and verbal consent from the concerned body and study subjects. The collected data were checked for completeness and consistency and was coded before data entry. Data were entered and cleaned analyzed using SPSS statistical package. RESULTS: Some 379 individuals provided data. Most of the respondents 348 (95.3%) had been sexually active during the past 12 months and 280 (84.1%) of them had more than one sexual partner. Seventy-five (19.8%) of the sexually active respondents used condoms consistently in the last 12 months. Had sex after drinking alcohol (adjusted OR=2.23; 95% CI (1.08, 4.61)),ever used substance (adjusted OR=4.37; 95% CI (1.18, 16.27)), had sex after consuming substance (Adjusted OR=4.37; 95% CI (1.18, 16.27)) and less education status (adjusted OR=0.38; 95% CI (0.16, 0.93)) were significantly associated with inconsistent condom use. CONCLUSION: There is a high inconsistency of condom use among federal police riot control. This indicates that the study populations are at higher risk of acquiring HIV infection. Substance use like khat, consuming alcohol, and low educational status was the significant predictor of inconsistent condom use among federal police riot control.

Post-treatment of tannery wastewater using pilot scale horizontal subsurface flow constructed wetlands (polishing).

In the present study, a pilot scale horizontal subsurface flow constructed wetland (CW) system planted with Phragmites karka; longitudinal profile was studied. The wetland was fed with tannery wastewater, pretreated in a two-stage anaerobic digester followed by a sequence batch reactor. Samples from each CW were taken and analyzed using standard methods. The removal efficiency of the CW system in terms of biological oxygen demand (BOD), chemical oxygen demand (COD), Cr and total coliforms were 91.3%, 90%, 97.3% and 99%, respectively. The removal efficiency for TN, NO3- and NH4+-N were 77.7%, 66.3% and 67.7%, respectively. Similarly, the removal efficiency of SO42-, S2- and total suspended solids (TSS) were 71.8%, 88.7% and 81.2%, respectively. The concentration of COD, BOD, TN, NO3-N, NH4+-N, SO42 and S2- in the final treated effluent were 113.2 ± 52, 56 ± 18, 49.3 ± 13, 22.75 ± 20, 17.1 ± 6.75, 88 ± 120 and 0.4 ± 0.44 mg/L, respectively. Pollutants removal was decreased in the first 12 m and increased along the CW cells. P. karka development in the first cell of CW was poor, small in size and experiencing chlorosis, but clogging was higher in this area due to high organic matter settling, causing a partial surface flow. The performance of the pilot CW as a tertiary treatment showed that the effluent meets the permissible discharge standards.

Year-to-year and seasonal variations in stunting among preschool children in Ethiopia.

The study was undertaken to investigate the year-to-year and seasonal variations in stunting among preschool children living at subsistence level in rural Ethiopia. Five thousand five hundred and eight anthropometric measurements were taken in 678 children (324 boys and 354 girls). The study classified 11.4% and 54.4% of the measurements as wasted and stunted respectively. Stunting occurred more frequently among girls (56.7%) and increased with increasing age. The prevalence of stunting increased from 47% in 1989 to 61% in 1994. In this subsistence farming community, the prevalence of stunting varied over time, especially among children aged 12-23 months. This may have practical consequences both for development work and for future research. Monitoring of year-to-year variations in stunting may suggest some indications of its long-term development in the community. Long-term studies are needed to understand the dynamics of the state of chronic malnutrition.